Rupendra Shakya /
As we all know,World health organization has declared the COVID-19 outbreak to be a public health emergency of international concern.
Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV-1] and SARS-CoV-2) have been transmitted from animals to people. In severe cases, coronaviruses can cause infection in the lungs (pneumonia), kidney failure and even death. Common signs are typical flu-like symptoms: a fever, cough, breathing difficulties, tiredness and muscle aches. Symptoms usually start within 3-7 days of exposure to the virus, but in some cases it has taken up to 14 days for symptoms to appear.People of all ages can be infected. The majority of people who have confined the virus did not need to be hospitalized for supportive care. However older people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appears to be more vulnerable to becoming severely ill with the COVID-19 virus.
It is a fact that people with diabetes are at increased risk of infections and complications such as secondary bacterial pneumonia. Diabetes patients have impaired immune-response to infection both in relation to cytokine profile and to changes in immune-responses including T-cell and macrophage activation. Poor glycemic control impairs several aspects of the immune response to viral infection and also to the potential bacterial secondary infection in the lungs. It is likely that many of the patients with diabetes in China have been in poor metabolic control when infected by COVID-19.
Many patients with type 2 diabetes are obese and obesity is also a risk factor for severe infection. The abnormal secretion of adipokines and cytokines like TNF-alfa and interferon characterize a chronic low-grade in abdominal obesity and may induce an impaired immune-response. People with severe abdominal obesity also have mechanical respiratory problems, with reduced ventilation of the basal lung sections augment the risk of pneumonia as well as reduced oxygen saturation of blood.Obese subjects also have an addition asthma risk, and those patients with obesity and asthma have more symptoms, more frequent and severe exacerbations and reduced response to several asthma medications. Late diabetic complications such as diabetic kidney disease and ischemic heart disease may complicate the situation for people with diabetes, making them frailer and further increasing the severity of COVID-19 disease and the need for care such as acute dialysis. Likewise, due to the overwhelming activity of corona virus, the patients with diabetes also fear and stressed, so during this condition the stress hormones glucocorticoids and cortisol release, which contribute for hyperglycemic condition.
Furthermore,Diabetes patientsare often treated with angiotensin-converting enzymes (ACE) inhibitors. Coronavirus binds to target cells through angiotensin-converting enzyme 2 (ACE2), which expressed in the epithelial cells in the lungs, blood vessels and in the intestine In patients treated with ACE and angiotensin II receptor blockers, expression of ACE2 is increased. It has been suggested that ACE2 expression may be increased inpatients with diabetes, which could facilitate infection with COVID-19 and increase the risk of severe disease and fatality. Therefore, diabetic patients should control the blood glucose level to hinder from covid-19 contagiousinfection.
(Asst. Professor and Medical Biochemist, (Crimson college and Crimson Hospital, Tinau International Hospital)